An unusual case of firearm injury to the face with bullet cover lodged in the nose.

We report an unusual case of an accidental firearm injury, in a 35-year-old male firearm trainer, by a bullet cover fired in a retrograde manner, which was lodged in his right nasal cavity just reaching sphenoid sinuses without any neurological impairment. The extent of tissue damage and posterior extent of tract was assessed by plain radiography and CT scans. The bullet cover was recovered under endoscopic guidance and the wound sutured with a small defect left for healing by secondary intention keeping in mind second stage reconstruction of the persisting defect. On follow up the wound had healed with good esthetic results. The case showed that gunshot injuries can be treated primarily as well that undermining of the edges of wound and regular well-lubricated dressings are key to good healing.

Recurrent epistaxis caused by an intranasal supernumerary tooth in a young adult.

PATIENT: Male, 27. FINAL DIAGNOSIS: Recurrent epistaxis. SYMPTOMS: Nasal bleeding. MEDICATION: -. CLINICAL PROCEDURE: -. SPECIALTY: Pediatrics and Neonatology. OBJECTIVE: Congenital defects/diseases. BACKGROUND: Recurrent epistaxis is a common disorder among children and young adults. We report an unusual cause, intranasal supernumerary tooth causing friction with Little's area of the nasal septum. CASE REPORT: A 22-year-old male presented with recurrent, mild, unilateral left-sided epistaxis once to twice per month for 3 years. This usually occurred after minor nasal trauma or rubbing his nose. The patient also suffered from recurrent tonsillitis. There was neither history of blood transfusion or nasal packing, nor a history suggestive of bleeding diathesis. Anterior rhinoscopy revealed ivory white nasal mass antero-inferiorly in the left nasal cavity touching Little's area. There was no bleeding. Nasal endoscopy showed a white cylindrical bony mass 1 cm long arising from the floor of the nose, with no attachment to the nasal septum or the lateral wall of the nose. Examination of the right nasal cavity was unremarkable. CONCLUSIONS: Nasal teeth result from the ectopic eruption of supernumerary teeth and may cause a variety of symptoms including recurrent epistaxis. Their clinical and radiologic presentation is so characteristic that their diagnosis is not difficult. CT scan is helpful in planning management. Early extraction prevents further complications and prevents further attacks of epistaxis.